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After completing this case study, the reader should be able to:

  • Recognize risk factors associated with development of erectile dysfunction (ED).

  • Provide brief descriptions of the advantages and disadvantages of the common therapies available for treating ED.

  • Recommend appropriate first- and second-line therapy for treatment of ED.

  • Provide appropriate patient education on administration and expected side effects of selected treatment modalities for ED.


Chief Complaint

“I’m having trouble in the bedroom lately….”


Peter Johnson is a 63-year-old man who presents to his PCP with the above complaint. On questioning, he states that for the past year he has been able to achieve only partial erections that are insufficient for intercourse. He notices occasional nocturnal penile tumescence. He feels that the problem is leading to a strained relationship with his wife. He has tried a couple of herbal products or “natural supplements” that he ordered over the Internet, but they did not help.


Type 2 DM × 14 years

Diabetic peripheral neuropathy



CKD stage 3


Father deceased at age 72 secondary to MI; mother alive with HTN


Married for 38 years; no history of marital problems; 20 pack-year smoking history; does not drink alcohol; walks for 30 minutes 3 days per week


Insulin glargine 60 units SC at bedtime

Metformin 1000 mg PO BID

Dulaglutide 1.5 mg SQ once weekly

Gabapentin 600 mg PO TID

Lisinopril 40 mg PO once daily

Hydrochlorothiazide 25 mg PO once daily

Atorvastatin 80 mg PO once daily

ASA 81 mg PO once daily




Denies significant life stressors, fatigue, urgency, or symptoms of prostatitis. Complains of occasional nocturia, numbness, burning and tingling in his feet, and difficulty achieving and maintaining erections.

Physical Examination


Alert, well-developed, cooperative man in NAD


BP 131/78 mm Hg, P 60 bpm, RR 18, T 37.2°C; Wt 120 kg, Ht 5′10″


Warm, dry; no lesions


NC/AT; EOMI; PERRLA; funduscopic examination shows no arteriolar narrowing, hemorrhages, or exudates

Neck/Lymph Nodes...

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